Provider Demographics
NPI:1508466277
Name:TAKACS, REGINA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:TAKACS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1166
Mailing Address - Country:US
Mailing Address - Phone:740-703-5197
Mailing Address - Fax:
Practice Address - Street 1:85 RIVER TRCE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2686
Practice Address - Country:US
Practice Address - Phone:740-774-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03219579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist